Evaluation of associated risk factors of near miss obstetrics cases at B.P. Koirala Institute of Health Sciences, Dharan, Nepal

Abstract

INTRODUCTIONWorldwide, more than half a million women between age 15-49 die each year from the complication of pregnancy and childbirth.1 Near misses have emerged as a useful complement to the investigation of maternal deaths. 2Near miss is defined as "A woman who nearly died but survived a complication that occurred during pregnancy, childbirth, or within 42 days of termination pregnancy. 2,3The patient survived either by chance or because of hospital care she received." Currently we have high pregnancy related mortality ratio (247 deaths due to any causes in pregnancy up to six weeks after pregnancy event per 100 thousand live births) and maternal mortality ratio (229 deaths due to pregnancy and childbirth related cause per 100 thousand live births) which constitutes 11% of deaths of women of reproductive age group.Various associated risk factors contribute to near miss events. Commonly seen in our context are: Antepartum/Postpartum hemorrhage, complication of abortion, ruptured ectopic and ruptured uterus, Hypertension complicating pregnancy: severe preeclampsia, eclampsia, sepsis or severe systemic ABSTRACT Background: In 2011, around 273,465 women died worldwide during pregnancy, childbirth or within 42 days after childbirth. Near-miss is recognized as the predictor of level of care and maternal death. The objective of the study was to evaluate the associated risk factors of near miss obstetric cases. Methods: A prospective observational study was done from August 1, 2014 to July 30, 2015 in Department of Obstetrics and Gynecology at BPKIHS hospital, tertiary care hospital in Eastern Nepal, Dharan. Case eligible by 5 factor scoring system and WHO near miss criteria were evaluated. Risk factors included severe hemorrhage, hypertensive disorders, complication of abortion, ruptured uterus, medical/surgical condition and sepsis. Results: A total of 9,727 delivery were attended during the study period from August 2014 to July 2014. There were 6307 (71.5%) vaginal delivery and 2777 (28.5%) caesarean section and 181 perinatal death with total of 9,546 livebirth. 162 near miss and 16 maternal death occurred during the study. Maternal near miss rate of 16.6 per 1000 live birth, Women with life-threatening conditions of 172, Severe maternal outcome ratio of 18.64, Maternal nearmiss: mortality ratio: 10.1:1, Mortality index: 8.98%. Risk factors were obstetric hemorrhage 27.8%, abortion/ectopic 27.2%, eclampsia 16%, medical/surgical condition 14.8%, sepsis 13.6%, severe preeclamsia 11.1%, ruptured uterus 3.1%, and molar pregnancy 1.9% and cardiovascular and coagulation dysfunction as a major life-threatening condition and sepsis (25%) was the major cause of mortality. Conclusions: Haemorrhage and hypertensive disorders are the leading causes of near miss event. Evaluation of associated risk factor can be potential tool for reduction of maternal morbity and mortality.

Determinants of maternal near-miss event’s among pregnant women attending tertiary care hospital: A case–control study

“…9 " It is utilized as a substitute for obstetric care evaluation. 10 Because a maternal near-miss is a precursor to a maternal death, identifying the risk factors for near-miss will aid in the development of maternal death prevention methods. 11 Near-miss rates have been reported to range from 0.6% to 14.98% in a comprehensive analysis utilizing diseasespecific criteria.…”

Maternal near miss at Kathmandu Medical College: An analysis of severe maternal morbidity at a Nepalese tertiary care facility

“…Within Nepal, there have been seven studies undertaken on MNM over the last ten years 8–14 . Five of these studies were undertaken at an institutional level, mostly at tertiary referral centres, while two were community‐based studies.…”

“…8 Within Nepal, there have been seven studies undertaken on MNM over the last ten years. [8][9][10][11][12][13][14] Five of these studies were undertaken at an institutional level, mostly at tertiary referral centres, while two were community-based studies. The majority of studies are descriptive in nature, with all but one utilising the World Health Organization (WHO) 'near miss' criteria to determine the level of maternal morbidity and mortality, identifying aetiologies of 'near miss' and evaluating quality of care using process indicators.…”